|
Implant cochlear osia osi300
|
$19,311.26 |
$19,311.26 |
$19,311.26 |
$16,195.55
|
|
Implant pulse generator remede el
|
$43,752.80 |
$43,752.80 |
$43,752.80 |
$43,752.80
|
|
In-111 autol wbc diag per dose
|
$1,265.71 |
$1,265.71 |
$1,265.71 |
$3,493.75
|
|
In-111 capromab pendet
|
$4,657.35 |
$4,657.35 |
$4,657.35 |
$3,141.45
|
|
In-111 ibritumomab tiux dx
|
$4,231.92 |
$4,231.92 |
$4,231.92 |
$4,748.02
|
|
In-111 oxyquinolin per 0.5 mci
|
$2,301.21 |
$2,301.21 |
$2,301.21 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$836.53 |
$836.53 |
$836.53 |
$2,598.17
|
|
In-111 pentetreotide
|
$4,693.70 |
$4,693.70 |
$4,693.70 |
$5,294.90
|
|
In-111 satumomab pend
|
$1,575.06 |
$1,575.06 |
$1,575.06 |
$3,113.04
|
|
Incision of tongue fold
|
$219.86 |
$219.86 |
$219.86 |
$1,792.50
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$236.38 |
$236.38 |
$236.38 |
$140.80
|
|
Infect ag drug suscept pheno predict
|
$501.82 |
$501.82 |
$501.82 |
$325.00
|
|
Infect ag genotype na hiv-1 other region
|
$1,003.63 |
$1,003.63 |
$1,003.63 |
$361.65
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$636.78 |
$636.78 |
$636.78 |
$603.83
|
|
Infect ag ia optc obs influenza
|
$53.48 |
$53.48 |
$53.48 |
$72.93
|
|
Infect ag na hpv high-risk types
|
$173.66 |
$173.66 |
$173.66 |
$139.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$145.94 |
$145.94 |
$145.94 |
$219.70
|
|
Infect ag na orthopoxvirus amp prb each
|
$186.76 |
$186.76 |
$186.76 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$1,950.20 |
$1,950.20 |
$1,950.20 |
$854.70
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$1,072.12 |
$1,072.12 |
$1,072.12 |
$954.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$63.00 |
$63.00 |
$63.00 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$156.52 |
$156.52 |
$156.52 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$58.24 |
$58.24 |
$58.24 |
$72.80
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$68.88 |
$68.88 |
$68.88 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$61.71 |
$61.71 |
$61.71 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$95.26 |
$95.26 |
$95.26 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$39.87 |
$39.87 |
$39.87 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$101.58 |
$101.58 |
$101.58 |
$60.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$46.26 |
$46.26 |
$46.26 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$296.63 |
$296.63 |
$296.63 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$34.66 |
$34.66 |
$34.66 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$510.16 |
$510.16 |
$510.16 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$150.64 |
$150.64 |
$150.64 |
$141.95
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$128.52 |
$128.52 |
$128.52 |
$167.05
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$1,094.74 |
$1,094.74 |
$1,094.74 |
$864.67
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$432.26 |
$432.26 |
$432.26 |
$181.35
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$133.22 |
$133.22 |
$133.22 |
$149.13
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$537.04 |
$537.04 |
$537.04 |
$212.16
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$150.64 |
$150.64 |
$150.64 |
$137.67
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$151.31 |
$151.31 |
$151.31 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$333.82 |
$333.82 |
$333.82 |
$206.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$423.47 |
$423.47 |
$423.47 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$165.31 |
$165.31 |
$165.31 |
$96.00
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$198.97 |
$198.97 |
$198.97 |
$112.45
|
|
Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae
|
$93.63 |
$93.63 |
$93.63 |
$217.60
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$423.47 |
$423.47 |
$423.47 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$316.46 |
$316.46 |
$316.46 |
$432.63
|
|
Infectious agent nucleic acid quantification bk virus
|
$291.93 |
$291.93 |
$291.93 |
$283.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$186.87 |
$186.87 |
$186.87 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$172.70 |
$172.70 |
$172.70 |
$253.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$170.80 |
$170.80 |
$170.80 |
$375.00
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$649.94 |
$649.94 |
$649.94 |
$304.20
|
|
Infliximab 100 mg intravenous solution
|
$2,171.51 |
$2,171.51 |
$2,171.51 |
$2,047.13
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$945.52 |
$945.52 |
$945.52 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$131.15 |
$131.15 |
$131.15 |
$296.00
|
|
Init ak ischal plstr direct
|
$3,289.10 |
$3,289.10 |
$3,289.10 |
$2,609.60
|
|
Init bk ptb plaster direct
|
$2,338.06 |
$2,338.06 |
$2,338.06 |
$2,148.48
|
|
Initial custom socket insert
|
$2,085.61 |
$2,085.61 |
$2,085.61 |
$1,453.20
|
|
Inj, abilify maintena, 1 mg
|
$4,765.94 |
$4,765.94 |
$4,765.94 |
$5,355.30
|
|
Inj acetaminophen -fresenius
|
$32.93 |
$32.93 |
$32.93 |
$36.60
|
|
Inj beta interferon sq 1 mcg
|
$1,721.76 |
$1,721.76 |
$1,721.76 |
$2,397.11
|
|
Inj, bortezomib, dr. reddy's
|
$135.52 |
$135.52 |
$135.52 |
$48.55
|
|
Inj, bupivacaine liposome
|
$732.96 |
$732.96 |
$732.96 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$31.39 |
$31.39 |
$31.39 |
$27.38
|
|
Inj, clindamycin (baxter)
|
$81.49 |
$81.49 |
$81.49 |
$48.30
|
|
Inj cntr knee arthro incl ct/mri
|
$678.10 |
$678.10 |
$678.10 |
$436.80
|
|
Inj. denosumab-bbdz, 1 mg
|
$5,215.73 |
$5,215.73 |
$5,215.73 |
$4,615.43
|
|
Inj dx for sinogram
|
$400.12 |
$400.12 |
$400.12 |
$436.00
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$414.06 |
$414.06 |
$414.06 |
$1,214.78
|
|
Injection arthrography hip without anesthesia (both sides)
|
$678.10 |
$678.10 |
$678.10 |
$503.50
|
|
Injection, daratumumab 10 mg
|
$5,023.56 |
$5,023.56 |
$5,023.56 |
$5,324.34
|
|
Injection epidural blood patch or clot
|
$374.36 |
$374.36 |
$374.36 |
$1,182.33
|
|
Injection for arthrography wrist (both sides)
|
$529.20 |
$529.20 |
$529.20 |
$436.00
|
|
Injection for bladder x-ray
|
$1,808.30 |
$1,808.30 |
$1,808.30 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$678.10 |
$678.10 |
$678.10 |
$497.76
|
|
Injection, fulvestrant
|
$3,402.24 |
$3,402.24 |
$3,402.24 |
$1,719.16
|
|
Injection radioactive tracer sentinel node (both sides)
|
$403.59 |
$403.59 |
$403.59 |
$685.44
|
|
Injection, renflexis
|
$880.05 |
$880.05 |
$880.05 |
$1,341.52
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$1,008.90 |
$1,008.90 |
$1,008.90 |
$1,582.12
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$993.44 |
$993.44 |
$993.44 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$993.44 |
$993.44 |
$993.44 |
$1,043.72
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,520.51 |
$1,520.51 |
$1,520.51 |
$2,040.36
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$140.17 |
$140.17 |
$140.17 |
$1,030.05
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$1,520.51 |
$1,520.51 |
$1,520.51 |
$1,855.36
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance
|
$164.70 |
$164.70 |
$164.70 |
$1,043.20
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$1,520.51 |
$1,520.51 |
$1,520.51 |
$2,006.79
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$893.26 |
$893.26 |
$893.26 |
$1,817.24
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$949.48 |
$949.48 |
$949.48 |
$1,685.00
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$732.59 |
$732.59 |
$732.59 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$660.35 |
$660.35 |
$660.35 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$97.44 |
$97.44 |
$97.44 |
$145.60
|
|
Inj epidural sgl cerv-thor without img
|
$594.16 |
$594.16 |
$594.16 |
$1,329.00
|
|
Inj epidural sgl lumb-sacral without img
|
$658.50 |
$658.50 |
$658.50 |
$1,450.84
|
|
Inj fluphenazine hcl 1.25 mg
|
$225.43 |
$225.43 |
$225.43 |
$40.33
|
|
Inj for ext venography
|
$678.10 |
$678.10 |
$678.10 |
$628.80
|
|
Inj heparin, pfizer, 1000u
|
$46.82 |
$46.82 |
$46.82 |
$25.30
|
|
Inj ivig privigen 500 mg
|
$4,026.46 |
$4,026.46 |
$4,026.46 |
$6,967.29
|
|
Inj, lanreotide, (cipla) 1mg
|
$7,229.26 |
$7,229.26 |
$7,229.26 |
$11,648.70
|
|
Inj levoleucovorin nos 0.5mg
|
$122.64 |
$122.64 |
$122.64 |
$110.40
|
|
Inj, levothyroxine, freskabi
|
$177.88 |
$177.88 |
$177.88 |
$308.21
|